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Traumatic Brain Injury:Traumatic Brain Injury: The Basics of TBI
Betsy Johnson, MA, CCC-SLPBrain Injury Association of Kansas and Greater Kansas City
Learning Objectives
Causes and consequences of TBI Causes and consequences of TBI How TBI can affect behavior,
relationships and the community How community resources can How community resources can
assist persons with brain injury and ftheir families
Definitions
Traumatic Brain Injury (TBI) is an insult to the Traumatic Brain Injury (TBI) is an insult to the brain caused by an external physical force or trauma; does not refer to the emotional ;trauma the injury causes for the person and family membersy
Acquired Brain Injury (ABI) is an injury to the brain that has occurred after birth. Includes: TBI, stroke, near suffocation, infections in the brain, tumor, etc.
The “Silent Epidemic”
TBI is a largely unrecognized major TBI is a largely unrecognized major public health problemM l d ’t d t d th Many people don’t understand the consequences of TBI or how it affects people
Some brain injuries are not perceived j pas a brain injury For example: A concussion is a type of TBI For example: A concussion is a type of TBI
Scope of the Problem
1.4 million people sustain a brain injury every1.4 million people sustain a brain injury every year as reported in ER visits
TBI is the leading cause of death and gdisability among children and young adults
TBI is the 4th leading cause of death overall CDC estimates 3.17 million people live with
disability from TBI Direct and indirect costs of TBI are about $60
million per year
Approximately 1 in 10 people is touched by
the effects of TBI
Other Stats
Blasts are the leading cause ofBlasts are the leading cause of TBI for active duty military personnel in war zones
More than 50% of all motor vehicle crashes resulting in TBI involve alcoholinvolve alcohol
40% of those hospitalized with TBI had at least 1 unmet needTBI had at least 1 unmet need for services one year post injury
Comparison of Annual Incidence
1400000
1000000
1200000
1400000
600000
800000
1000000
200000
400000
600000
0
200000
MS Spinal CordInjury
HIV/AIDS Breast Cancer TBIInjury
Causes of Traumatic Brain Injury
9%
Falls
28%
13%
9%
MVA
Struck by/against
AssaultAssault
Other
Unknown11%
20%19%
Survival Rates are Increasing
Reasons Reasons Improved medical technology Mandated safety features such as seatbelts child Mandated safety features such as seatbelts, child
safety seats and airbags Resulting ing More people living with the affects of TBI Long term affects are being discoveredg g
Those that have sustained a TBI are at higher risk for Alzheimer’s disease and Parkinson’s disease
Sports Concussions
Research suggests that although there may Research suggests that although there may not be damage to the brain anatomy, there is a disturbance to the brain metabolism
It is estimated that 1.6 to 3.8 million sports related concussions occur yearlyrelated concussions occur yearly
If a player returns to play too soon, could result in Second Impact Syndromeresult in Second Impact Syndrome
From presentation by Jamie Pardini, PhD University of Pittsburgh Medical Center
Risk Factors for TBI
Males are 1 5 times more likely than females Males are 1.5 times more likely than females to sustain a TBI
Age groups at highest risk for TBI are 0-4 Age groups at highest risk for TBI are 0-4 year olds and 15-19 year olds
Certain military duties have a higher risk of Certain military duties have a higher risk of sustaining TBI (i.e. paratroopers)
African Americans have the highest death African Americans have the highest death rate from TBI
No one is immune from sustaining a TBI!
Things to Consider About Brain Injury
Brain injury can change everything about us Brain injury can change everything about us in a matter of seconds
It affects who we are the way we think act It affects who we are, the way we think, act and feel
A person with a brain injury is a person first A person with a brain injury is a person first No two injuries to the brain are alike
N t l th No two people recover the same Effects are complex and vary for each person
Severity Ratings for TBI
Mild Mild Brief or no loss of consciousness; concussion
Moderate Moderate Loss of consciousness that can last a few hours
Severe Severe Prolonged loss of consciousness
S i f TBI d diSeverity of TBI does not predict long-term outcomes!!long term outcomes!!
What Can Change after Brain Injury
CognitiveCognitive Attention, memory, executive function, processing
speed, perception, inflexibility; language skills Physical Motor coordination, spasticity, flaccidity, balance,
weakness changes in any of the 5 sensesweakness, changes in any of the 5 senses Can affect mobility and speech
Emotional/Behavioral Emotional/Behavioral Depression, anxiety, difficulty with relationships,
disinhibition, control of emotions, initiation
Recovery
Measured in weeks, months, yearsMeasured in weeks, months, years Survivors can face long periods of time without
sufficient services Community resources are needed to help fill gaps in
service
50
100
150
Pre-injury Status
Recovery of Skills0
0 3 6 9 12 15 18 21 24 27 30 33 36
Recovery of Skills
Months post-injury (based on FIM scores)Months post injury (based on FIM scores)
References
Specific referencing p gsources for previous slides can be found on Brain Injury Association of America’s website, www.biausa.org,
d h “Abunder the “About Brain Injury” tab.
More about “Attention”
Attention/concentration is considered a foundationAttention/concentration is considered a foundation skill of cognition
This is often impaired following TBI Impaired attention results in difficulties with memory Those with impaired attention can become easily
distracted which leads to frustration Increased frustration leads to decreased ability to
pay attentionpay attention So the cycle goes…
More about “Memory”
There are many types of memoryThere are many types of memory A person can have impairment for some
types of memory and not othersyp y Difficulty with memory can lead to difficulty in
higher level independent living skills Memory strategies can make a person
functional, but many are complex to learn Ability to remember can be different from day
to day – sometimes this is unpredictable
More about “Executive Function”
This is complex skill is found in the brain in the This is complex skill is found in the brain in the frontal lobe – the part behind the forehead
The frontal lobe is very susceptible to damage The frontal lobe is very susceptible to damage Executive Function consists of the highest
level of cognitive skillslevel of cognitive skills Includes: decision making, ability to
organize/prioritize error correction ability toorganize/prioritize, error correction, ability to predict in a novel situation, self regulation
Community Profile 1
Female, age 45 years, fell on the job whileFemale, age 45 years, fell on the job while walking too fast
She did not lose consciousness Scans of her brain came back “clean” Family reports sudden personality changey p p y g She cannot work more than an hour before
becoming very anxious, including panic attacks
She does not have obvious signs of injury
Impact on Family
Some family members have become Some family members have become alienated due to personality changes
Some family members consider her “lazy” Some family members consider her lazy and/or a hypochondriac
Family may have to move to smaller home Family may have to move to smaller home due to decrease in income
Strains on all relationships within family Strains on all relationships within family Roles within family have changed
Community Profile 2
Male age 23 was involved in motor vehicle Male, age 23, was involved in motor vehicle accident
He was in a coma for 2 weeks He was in a coma for 2 weeks Due to severe ataxia (tremors), he is not able
to control muscle movementto control muscle movement He is in an electric wheelchair
H i 24 h He requires 24 hour care He is not able to hold any type of job
Impact on Family
Family’s home had to have physical Family s home had to have physical accommodations made for wheelchair
Family fun activities have been affected Family fun activities have been affected, including annual vacations
One family member had to quit job in order to One family member had to quit job in order to be at home during the day to assist with activities of daily livingactivities of daily living
Strains on finances and family dynamics interfere with relationshipsinterfere with relationships
Community Profile 3
Male age 62 fell while riding a bike Male, age 62, fell while riding a bike Was found unconscious
Swelling of the brain resulted in diffuse Swelling of the brain resulted in diffuse damage affecting higher levels of cognitionN b i h i l i i t No obvious physical impairment
He easily becomes agitated in public places Becomes easily confused, requiring 24 hour
care for redirection purposes only
Impact on Family
His wife has taken on the additional role of His wife has taken on the additional role of primary caregiver, or mothering role
He requires one-on-one attention in public He requires one-on-one attention in public places due to confusion and agitation
Caregivers have been hired to assist with Caregivers have been hired to assist with supervision within the home, adding to his confusion by having strangers aroundconfusion by having strangers around
Friends have distanced themselves due to behavior changesbehavior changes
Community Resources
Profile 1 Profile 1 Family counselling at reduced rate Financial assistance Financial assistance
Profile 2 Respite services during family vacations Respite services during family vacations Assistance with building ramps
Profile 3 Profile 3 Respite services that will not increase agitation Assistance within the community public places Assistance within the community – public places
Contact Information
Brain Injury Association of Kansas and Brain Injury Association of Kansas and Greater Kansas City www.biaks.org www.biaks.org
State of Kansas TBI program website State of Kansas TBI program website www.tbikansas.org
Brain Injury Association of America www biausa org www.biausa.org